A prospective, multidisciplinary evaluation of premenopausal women with iron-deficiency anemia.

OBJECTIVE: The cause of iron deficiency anemia (IDA) in premenopausal women is often presumed to be menstrual blood loss. The purpose of this study was to determine the diagnostic value of a comprehensive gynecological and gastrointestinal evaluation in premenopausal women with IDA. METHODS: Nineteen premenopausal, nonpregnant women older than 18 yr of age with IDA defined by a hemoglobin < 12 gm/dl with serum ferritin < 10 ng/ml participated in the study. Evaluations included directed history and physical examination by a specialist in gynecology and a subspecialist in gastroenterology, esophagogastroduodenoscopy, colonoscopy, upper gastrointestinal radiography with small bowel follow-through, antiendomysial antibody, and fecal occult blood tests. RESULTS: Seven of 19 (37%) premenopausal women with IDA were diagnosed to have a gynecological cause of anemia by a specialist in that field. Although only four of these seven patients had digestive complaints, all but one (86%) were discovered to have gastrointestinal disease by upper endoscopy; findings were duodenal ulcer and Helicobacter pylori (H. pylori) gastritis (one), esophagitis and H. pylori gastritis (one), erosive esophagitis (one), gastric arteriovenous malformations (one), and nodular/erosive H. pylori gastritis (two). Fecal occult blood testing was positive in only two (29%) subjects; upper endoscopy revealed erosive esophagitis and gastric arteriovenous malformations. Twelve of the 19 (63%) premenopausal women with IDA were not diagnosed to have a gynecological source of anemia by a specialist in that field. Fecal occult blood testing was negative among all women tested and the only digestive complaint was heartburn (pyrosis) in seven. Each was identified to have esophagitis, duodenal ulcer, or gastritis by upper endoscopy. Colonoscopic examination of the 12 subjects without gynecologic etiology for IDA revealed pan colitis (one), diverticulosis (one), diverticulosis and melanosis coli (one), hyperplastic polyps (one), and nodular lymphoid aggregates (one). CONCLUSIONS: Significant upper gastrointestinal disease is identifiable among most premenopausal women with IDA (18 of 19 or 95%), even when careful evaluation by a specialist in gynecology suggests a gynecological source. Upper endoscopy should be considered in the evaluation of all premenopausal women with IDA expressing digestive complaints or in those with IDA refractory to iron supplementation. Lower endoscopic examination may be reserved for those women with symptoms or signs suggestive of colorectal disorders.

Medical care of Iraqis at a forwardly deployed U.S. Army hospital during Operation Desert Storm.

To evaluate the injuries and diseases and their subsequent care for both Iraqis and U.S. soldiers in the Persian Gulf War, we analyzed all 196 admissions to the 46th Combat Support Hospital during Operation Desert Storm, with primary focus on the 118 admissions during the Ground War. Admission diagnosis was used to classify injury or disease. Percentage of patients who underwent surgery for combat wounds and percentage of patients who were air-evacuated were used as measurements of quality of care. The proportion of Iraqi patients who had been wounded in action was significantly higher than the proportion for Americans (95 vs. 53% for the Ground War). The rate of surgical procedures per wounded patients admitted was the same for Iraqis (28%) as for Americans (27%). Rates of air-evacuation for Iraqis were not statistically different from those for Americans in the same category of admission diagnoses. These last two findings suggest that the quality of care given to Iraqis was the same as that given to Americans.

The inpatient experience of a U.S. Army combat support hospital in the Persian Gulf during non-combat and combat periods.

To identify the key factors that control the workload of a U.S. military hospital during deployment, we studied all 574 admissions to the 46th Combat Support Hospital (CSH) during its deployment during Operations Desert Shield and Desert Storm. Date of admission, admission diagnosis, admitting service, length of hospitalization, disposition, nationality, and sex for each admission were analyzed. The workload of the 46th CSH varied markedly during the different periods of its deployment. Three hundred seventy-eight (66%) of the 574 admissions occurred during Operation Desert Shield, although admissions occurred at the greatest rate during the short Ground War phase of Operation Desert Storm. Iraqis accounted for 82% of the admissions during the Ground War and 51% of the total Desert Storm admissions. The most important factors determining the workload of the 46th CSH were the combat situation, effectiveness of the air-evacuation system, and the obligation to treat enemy soldiers and civilians.

Esophagogastroduodenoscopy in a small Army community hospital.

This is a review of the use of esophagogastroduodenoscopy (EGD) in a small Army community hospital. The method used was retrospective review of all patients who had EGD during a 4-month period. Patient demographics, indications for the procedure, and diagnoses were topics monitored. The most frequent indication for EGD was recurrent dyspepsia in patients already on H2 blockers. The most common diagnosis was gastritis and "gross" observation by examiners closely correlated with histologic diagnosis. EGD is performed for standard indications on a variety of patients at Cutler Army Community Hospital. Normal exams occurred at an acceptable rate and histological correlation with "gross" appearance was good.